cefotaxime and Meningitis--Meningococcal

Topics: Cefotaxime; Ceftriaxone; Drug Administration Schedule; Drug Resistance, Microbial; Haemophilus influenzae; Humans; Meningitis, Haemophilus; Meningitis, Meningococcal; Neisseria meningitidis; Penicillin Resistance

Topics: Age Factors; Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Bacteria; Cefotaxime; Ceftriaxone; Cefuroxime; Cerebrospinal Fluid; Child, Preschool; Chloramphenicol; Humans; Infant; Infant, Newborn; Meningitis; Meningitis, Haemophilus; Meningitis, Listeria; Meningitis, Meningococcal; Meningitis, Pneumococcal; Prognosis; Spinal Puncture

Evidence from a recent randomized controlled trial suggests that dexamethasone as adjunct therapy in adult pneumococcal meningitis reduces mortality and neurological sequelae. However, adding dexamethasone has the potential to reduce penetration of vancomycin into the cerebrospinal fluid (CSF). We sought to determine concentrations of vancomycin in serum and CSF of patients with suspected or proven pneumococcal meningitis receiving dexamethasone to assess the penetration of vancomycin into the CSF during steroid therapy.. In an observational open multicenter study, adult patients admitted to the intensive care unit because of suspected pneumococcal meningitis received recommended treatment for pneumococcal meningitis, comprising intravenous cefotaxime (200 mg per kg of body weight per day), vancomycin (administered as continuous infusion of 60 mg per kg of body weight per day after a loading dose of 15 mg per kg of body weight), and adjunctive therapy with dexamethasone (10 mg every 6 h). Vancomycin levels in CSF were measured on day 2 or day 3 of therapy and were correlated with protein levels in CSF and vancomycin levels in serum (determined at the same time as levels in CSF).. Fourteen patients were included. Thirteen had proven pneumococcal meningitis; 1 patient, initially suspected of having pneumococcal meningitis, was finally determined to have meningitis due to Neisseria meningitidis. Mean levels of vancomycin in serum and CSF were 25.2 and 7.2 mg/L, respectively, and were positively correlated (r=0.6; P=.025). A positive correlation was also found between the ratio of vancomycin in CSF to vancomycin in serum and the level of protein in CSF (r=0.66; P=.01).. Appropriate concentrations of vancomycin in CSF may be obtained even when concomitant steroids are used. Dexamethasone can, therefore, be used without fear of impeding vancomycin penetration into the CSF of patients with pneumococcal meningitis, provided that vancomycin dosage is adequate. This study is registered at http://www.ClinicalTrials.gov/ (registration number NCT00162578).

Topics: Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents; Cefotaxime; Dexamethasone; Female; Humans; Male; Meningitis, Meningococcal; Meningitis, Pneumococcal; Middle Aged; Vancomycin

Cefotaxime (CTX) and ceftriaxone (CRO) were compared for cerebrospinal fluid (CSF) penetration and antimicrobial efficacy in cases of bacterial meningitis in children. This was a comparative study of CRO (100mg/kg once daily) and CTX (50 mg/kg 6 hourly) in the treatment of children with bacterial meningitis. The aetiological agents included Streptococcus pneumoniae (SPn), Haemophilus influenzae type b (Hib) and Neisseria meningitidis (NMen). Minimum inhibitory concentrations (MICs) were measured. In 33 patients from whom a second CSF specimen was obtained, CSF was cultured and assayed for antibiotic concentration. Median MICs of CTX and CRO for SPn, Hib and NMen were 0.01 and 0.01 microg/mL, 0.004 and 0.002 microg/mL and 0.008 and 0.004 microg/mL, respectively. All 33 repeat lumbar puncture specimens were sterile. The lowest CSF level recorded (0.45 microg/mL for CTX) was 45 times the MIC (0.01 microg/mL). The highest levels (24-35 microg/mL for CRO) were up to 8750 times the MIC of the patient's causative organism. A wide range of CSF levels for both antibiotics was observed. Levels varied with post-dose interval and duration of illness. On the basis of these findings, clinicians should be reassured that repeat lumbar puncture is not recommended for the causative organisms in this study (i.e., for Hib, NMen and penicillin/cefotaxime/ceftriaxone fully-susceptible SPn).

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Female; Haemophilus influenzae type b; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal

In experimental models of meningitis and in children with meningitis, dexamethasone has been shown to reduce meningeal inflammation and to improve the outcome of disease.. We conducted a placebo-controlled, double-blind trial of dexamethasone therapy in 101 infants and children admitted to the National Children's Hospital, San José, Costa Rica, who had culture-proved bacterial meningitis or clinical signs of meningitis and findings characteristic of bacterial infection on examination of the cerebrospinal fluid. The patients were randomly assigned to receive either dexamethasone and cefotaxime (n = 52) or cefotaxime plus placebo (n = 49). Dexamethasone (0.15 mg per kilogram of body weight) was given 15 to 20 minutes before the first dose of cefotaxime and was continued every 6 hours thereafter for four days.. The demographic, clinical, and laboratory profiles were similar for the patients in the two treatment groups. By 12 hours after the beginning of therapy, the mean opening cerebrospinal pressure and the estimated cerebral perfusion pressure had improved significantly in the dexamethasone-treated children but worsened in the children treated only with cefotaxime (controls). At 12 hours meningeal inflammation and the concentrations of two cytokines (tumor necrosis factor alpha and platelet-activating factor) in the cerebrospinal fluid had decreased in the dexamethasone-treated children, whereas in the controls the inflammatory response in the cerebrospinal fluid had increased. At 24 hours the clinical condition and mean prognostic score were significantly better among those treated with dexamethasone than among the controls. At follow-up examination after a mean of 15 months, 7 of the surviving 51 dexamethasone-treated children (14 percent) and 18 of 48 surviving controls (38 percent) had one or more neurologic or audiologic sequelae (P = 0.007); the relative risk of sequelae for a child receiving placebo as compared with a child receiving dexamethasone was 3.8 (95 percent confidence interval, 1.3 to 11.5).. The results of this study, in which dexamethasone administration began before the initiation of cefotaxime therapy, provide additional evidence of a beneficial effect of dexamethasone therapy in infants and children with bacterial meningitis.

Topics: Adolescent; Bacterial Infections; Cefotaxime; Cerebrospinal Fluid Pressure; Child; Child, Preschool; Dexamethasone; Double-Blind Method; Female; Hearing Disorders; Humans; Infant; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Nervous System Diseases; Tumor Necrosis Factor-alpha

In a multicentre study, 220 consecutive cases of bacterial meningitis in children older than 3 months were randomised to treatment with chloramphenicol, ampicillin (initially with chloramphenicol), cefotaxime, or ceftriaxone. The drugs were given in four equal daily doses for 7 days, except ceftriaxone which was given only once daily. 200 cases could be assessed; the causative organisms were Haemophilus influenzae type b (Hib) in 146; meningococci (Mnc) in 32; pneumococci (Pnc) in 13; and other or unknown in 9. In patients with Hib meningitis, sterilisation of the cerebrospinal fluid occurred most rapidly with ceftriaxone. Otherwise, in terms of overall clinical recovery, normalisation of laboratory indices, clinically significant adverse reactions, toxic effects, sequelae, and mortality rate, the treatment groups were very similar. However, there were 4 bacteriological failures, all in the chloramphenicol group. Also, the treatment was extended or changed in more cases in the chloramphenicol group than in the other groups. Chloramphenicol was thus inferior to the other three antimicrobials. Ampicillin is a good and cheap alternative, but there are difficulties with resistance. Easy administration tempts the use of ceftriaxone rather than cefotaxime but it causes diarrhoea. A 7-day course of ampicillin, cefotaxime, or ceftriaxone is sufficient in Hib, Mnc, or Pnc meningitis.

Topics: Adolescent; Ampicillin; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Female; Finland; Follow-Up Studies; Humans; Infant; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Multicenter Studies as Topic; Random Allocation; Recurrence

Seventy-nine children were enrolled in a study to compare seven vs ten days of ceftriaxone therapy for bacterial meningitis. On the basis of a computer-generated list of therapy assignments, 35 children with Haemophilus, pneumococcal, or group B streptococcal meningitis each were assigned to seven- or ten-day treatment regimens; nine children with meningococcal meningitis received seven days of therapy. The population characteristics and etiologic agents were similar for the two treatment groups, as were also the findings on examination and culture of cerebrospinal fluid at completion of therapy. There were no significant differences in the frequency and types of neurological complications between the two treatment groups; four patients in each group had two or more neurological abnormalities. The rates of nosocomial infections and prolonged and secondary fever were similar in those who received seven days of therapy compared with patients treated for the conventional ten days. Diarrhea occurred in 44% of those receiving the drug. Patients treated with the seven-day regimen were discharged from the hospital approximately two days earlier than those with the ten-day regimen.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Child, Preschool; Female; Humans; Infant; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Streptococcal Infections; Streptococcus agalactiae

Forty-five children (aged 1 day to 15 years) with bacterial meningitis were randomized to receive either traditional therapy (ampicillin and chloramphenicol or gentamicin, pending sensitivity) or ceftriaxone (100 mg/kg per day in two doses for a minimum of 10 days). The etiological agents involved were similar for the two groups and included Haemophilus influenzae type b, Neisseria meningitidis, Streptococcus pneumoniae, and group B streptococcus. Repeat spinal taps were carried out 24 to 48 h after admission. Organisms were seen on the Gram stain of one patient treated with ceftriaxone, but five patients in the traditional therapy group had organisms present on Gram stain of uncentrifuged spinal fluid or positive cultures of the spinal fluid (or both). Ceftriaxone entered the cerebrospinal fluid well, and the average cerebrospinal fluid bactericidal activity for ceftriaxone 1 h after a dose was at least 60 times greater than for ampicillin or chloramphenicol. In those patients who received treatment for a long enough period of time to permit evaluation, there was one death in each group, both due to S. pneumoniae. The length of fever and complications were similar for the patients in both groups. Ceftriaxone was well tolerated; diarrhea, seen in 5 of the 22 patients who received the drug, was the most commonly encountered adverse effect. It was mild, and in no case was it necessary to discontinue the drug. Ceftriaxone appears in this preliminary study to be a safe and acceptable single agent for the treatment of bacterial meningitis in children.

Topics: Adolescent; Ampicillin; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Female; Gentamicins; Humans; Infant; Infant, Newborn; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Random Allocation

Ceftriaxone is a new cephalosporin with a broad spectrum of antibacterial activity and unique serum and CSF pharmacokinetics. The drug was compared in a randomized fashion with ampicillin and chloramphenicol in the treatment of 19 children with Haemophilus influenzae type b meningitis. Ceftriaxone was also administered non-randomly to six other patients including three children with Gram-negative meningitis. Among the children with H. influenzae meningitis, no deaths were noted and the outcomes of the study and the control groups were similar. Ninety per cent of the isolates of H. influenzae were inhibited by 0.0625, 1 and 1 mg/l of ceftriaxone, ampicillin and chloramphenicol respectively. One child with pneumococcal meningitis and two children with meningococcal meningitis recovered rapidly and without incident during ceftriaxone therapy. Three children with Gram-negative meningitis caused by multiply-drug resistant organisms were bacteriologically cured within five days of the onset of therapy. Persistent pleocytosis and neurological disabilities were noted in two at the conclusion of therapy. Ceftriaxone, as a single agent, was comparable in efficacy with traditional antimicrobial therapy usually employed in childhood meningitis.

Topics: Adolescent; Ampicillin; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Drug Therapy, Combination; Female; Humans; Infant; Male; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Random Allocation

78 patients with bacterial meningitis were evaluated in a prospective, randomised study comparing twice-daily ceftriaxone as single-drug therapy with ampicillin and chloramphenicol given every 6 h. The groups were comparable in age, sex, days of illness before admission, and bacterial colony counts in cerebrospinal fluid (CSF). The pathogens were Haemophilus influenzae type b (54 cases), streptococci (9 cases), meningococci (9 cases), and unknown (6 cases). In 40 CSF specimens obtained 4-12 h after initiation of therapy, cultures were negative in 57% of the ceftriaxone patients and in 42% of the others. The mean falls in the CSF bacterial colony counts were 4.7 and 5.0 log10 colony-forming units/ml, respectively. Mean bactericidal activity in CSF was significantly greater in the ceftriaxone than in the conventional treatment group at the beginning and end of therapy. There were no significant differences in clinical responses or in frequency of complications, except for mild diarrhoea, which occurred in 16 ceftriaxone patients and in 8 in the other group (p less than 0.05).

Topics: Adolescent; Ampicillin; Cefotaxime; Ceftriaxone; Cerebrospinal Fluid; Child; Child, Preschool; Chloramphenicol; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Infant; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Prospective Studies; Random Allocation

Ceftriaxone has greater in vitro and in vivo efficacy against many common bacteria than other third-generation cephalosporins. Single-dose ceftriaxone pharmacokinetics were studied in 17 patients, aged 0.6 to 52 months, with infections of the central nervous system. Patients received a randomized dose of 50 or 75 mg/kg ceftriaxone intravenously over 5 minutes on the second to fifth day of illness. Serial blood samples were collected over 24 hours in all patients, and cerebrospinal fluid (CSF) was obtained 1 to 4.5 hours after injection. Ceftriaxone mean peak plasma concentrations, determined by high-power liquid chromatography, were 267 and 184 microgram/ml for the 75 and 50 mg/kg dosage groups, respectively. The harmonic mean elimination half-life was 4.2 hours, and the mean percent drug penetrance into CSF was 4.8 +/- 3.5%. Of CSF studies evaluated, the glucose concentration was correlated most closely (inversely) with CSF penetration of ceftriaxone. Individual CSF concentrations of ceftriaxone exceeded the minimal inhibitory concentrations of the respective bacteria causing infection by 480 to 5,600 times. Ceftriaxone may be useful in the treatment of serious pediatric infections, including meningitis.

Topics: Cefotaxime; Ceftriaxone; Child, Preschool; Chromatography, High Pressure Liquid; Female; Half-Life; Humans; Infant; Kinetics; Male; Meningitis, Haemophilus; Meningitis, Meningococcal; Random Allocation

Topics: Anti-Bacterial Agents; Cameroon; Cefotaxime; Drug Resistance, Bacterial; Humans; Meningitis, Meningococcal; Microbial Sensitivity Tests; Neisseria meningitidis

To determine the common aetiolog of acute bacterial meningitis in children and their antibiotic susceptibility pattern.. A retrospective study with a review of cerebrospinal fluid culture reports of paediatric patients aged 0-15 years, suspected of acute meningitis in the Medical Microbiology Department of Aminu Kano Teaching Hospital, Kano, Nigeria from October 2006 to October 2009 from October 2006 to October 2009.. A positive culture bacterial isolation rate of 3.3% (n=50/1500) with prevalence of Streptococcus pneumoniae (24%), Neisseria meningitidis (22%), Escherichia coli (16%), Haemophilus influenzae (14%), Group B streptococci (8%) and Enterococci (8%) which were susceptible to ceftriaxone (96%), cefotaxime (95%) and ciprofloxacin (93%) across the bacterial isolates. Neonates were 55% (n=6.8/12.4) most at risk.. Neonates are the most at risk of acute bacterial meningitis. In the absence of antibiotic susceptibility report, ceftriaxone should be considered as a first choice reliable antibiotic for empirical treatment of meningitis in children, in this environment.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cerebrospinal Fluid; Child; Child, Preschool; Ciprofloxacin; Enterococcus; Escherichia coli; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Meningitis, Escherichia coli; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Nigeria; Retrospective Studies; Streptococcus agalactiae; Tertiary Care Centers

We report here on the identification of the first meningococcal meningitis case in Slovenia caused by Neisseria meningitidis serogroup Z’ in December 2010. The 19-year-old patient had not left the country during the incubation period. The patient was hospitalised and given the antibiotic treatment with cefotaxime very early in the course of the disease. The patient did not develop any complications during hospitalisation and was discharged on 5 January 2011.

Topics: Adult; Anti-Bacterial Agents; Cefotaxime; Contact Tracing; Humans; Male; Meningitis, Meningococcal; Neisseria meningitidis; Polymerase Chain Reaction; Post-Exposure Prophylaxis; Serotyping; Slovenia; Treatment Outcome

The authors describe a case of relapse of Neisseria meningitidis serogroup B meningitis in a 21-y-old male, 48 h after a 5-day treatment with cefotaxime 215 mg/kg per day. Brain magnetic resonance imaging (MRI) excluded the hypothesis of cerebral abscess or central venous septic thrombosis, and transthoracic echocardiography excluded bacterial endocarditis. Complement, properdin, and protein electrophoresis were normal. The plausible explanations for this relapse and the implications for other similar cases are discussed.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Cefotaxime; Dexamethasone; DNA, Bacterial; Humans; Male; Meningitis, Meningococcal; Neisseria meningitidis, Serogroup B; Recurrence; Young Adult

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Cesarean Section; Clavulanic Acid; Female; Fever; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infectious Disease Transmission, Vertical; Male; Maternal Exposure; Meningitis, Meningococcal; Neisseria meningitidis, Serogroup B; Penicillin G; Pregnancy; Pregnancy Complications, Infectious; Respiratory Tract Infections; Seizures; Treatment Outcome

Topics: Anti-Bacterial Agents; Cefotaxime; Child, Preschool; Disseminated Intravascular Coagulation; Fluid Therapy; Humans; Intracranial Hypertension; Meningitis, Meningococcal; Meningococcal Vaccines; Polysaccharides, Bacterial; Sepsis

* Young infants who have meningitis may present with nonspecific clinical manifestations. * S. pneumoniae and N. meningitidis remain the most common causes of bacterial meningitis in the infant and child, and GBS continues to be the most common neonatal pathogen. * Empiric therapy for suspected bacterial meningitis in a non-neonate includes a combination of parenteral vancomycin and either cefotaxime or ceftriaxone. * Children whose GCS scores are less than 8, show signs of shock or respiratory compromise, and have focal neurologic findings or clinical signs of elevated intracranial pressure should be admitted to a pediatric intensive care unit. * Sensorineural hearing loss occurs in 30% of children who have pneumococcal and 10% of those who have meningococcal meningitis.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Drug Therapy, Combination; Hearing Loss; Humans; Incidence; Infant; Intracranial Hypertension; Meningitis; Meningitis, Bacterial; Meningitis, Meningococcal; Vancomycin

To determine the probability of meropenem (Merrem, AstraZeneca Pharmaceuticals L.P., Wilmington, DE, USA) and cefotaxime (Claforan, Aventis Pharmaceuticals Inc., Bridgewater, NJ, USA) achieving bactericidal exposures in the cerebrospinal fluid against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae.. A 5,000-patient Monte Carlo simulation in a population of 10-year-old children with meningitis was conducted. Pediatric pharmacokinetic data were derived from the literature. Pathogen minimum inhibitory concentrations (MICs) were obtained from common bacteria that had caused meningitis collected during pediatric clinical trials. Time above the MIC exposures in the cerebrospinal fluid was calculated. Bactericidal exposure or probability of target attainment was defined as 40% and 50% time above the MIC for meropenem and cefotaxime, respectively. High cumulative fractions of responses were defined as >90% probability of target attainment against the populations of bacteria.. Meropenem was calculated to achieve 94.7%, 94.3%, and 96.1% cumulative fractions of response against S. pneumoniae, H. influenzae, and N. meningitidis, respectively. Cefotaxime only achieved a high likelihood of bactericidal attainment against N. meningitidis (91.6%). Against S. pneumoniae and H. influenzae, cefotaxime was only calculated to achieve 84.3% and 84.8% cumulative fractions of response, respectively.. In a simulated population of 10-year-old children, meropenem had a high likelihood of attaining bactericidal exposures in the cerebrospinal fluid. Cefotaxime had a >90% cumulative fraction of response against only N. meningitidis. Therefore, at the doses simulated, meropenem may be a more appropriate empiric choice for the treatment of bacterial meningitis in pediatric patients presumed to be caused by these pathogens until culture and susceptibility data are available.

Topics: Anti-Bacterial Agents; Body Weight; Cefotaxime; Child; Computer Simulation; Dose-Response Relationship, Drug; Humans; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Meropenem; Monte Carlo Method; Thienamycins

Meningococcal disease due to Neisseria meningitidis of serogroup W135 (N. meningitidis W135) is increasing in France. Clinical and outcome data concerning these infections in children are scarce. We report five cases of children hospitalized between June 2000 and December 2002 for N. meningitidis W135 infection. Extra-meningeal septic and/or non-septic complications were frequent and a prolonged post meningococcal inflammatory syndrome was reported. In N. meningitidis W135 infections a careful clinical evaluation of potential extra-meningeal complications and a long term follow up of children are needed.

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Cefotaxime; Child; Child, Preschool; Ciprofloxacin; Female; Follow-Up Studies; Fosfomycin; Humans; Infant; Male; Meningitis, Meningococcal; Meningococcal Infections; Neisseria meningitidis; Pericarditis; Time Factors; Treatment Outcome; Uveitis

Two major outbreaks of meningitis due Neisseria meningitidis serogroup A occurred in Senegal in 1998 and 1999. The purpose of this report is to describe clinical, bacteriological and therapeutic findings in 70 patients admitted for cerebrospinal meningitis to the Infectious Disease Clinic at the Fann University Teaching Hospital in Dakar in 1999. Diagnosis was based on direct microscopic examination after Gram staining in 71% of the cases, culture in 76%, and detection of soluble antigens in cerebrospinal fluid in 24%. Median patient age was 20 years. The highest incidence, i.e. 66% of cases, was recorded during February, March and April. Meningitic syndrome and fever were observed with 86% of the cases. The average duration of antibiotic therapy was 8 days. Chloramphenicol was the most commonly used drug (84% of cases). All strains identified in cultures were sensitive to chloramphenicol, ceftriaxone and cefotaxime but resistant to cotrimoxazole. Outcome was favorable in 93% of the cases. Three patients (4%) died and two (3%) developed hearing loss. Despite the low death rate in this series of patients treated in a hospital setting, mass vaccination is still the most effective mean of controlling meningococcal meningitis.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Female; Haemophilus influenzae; Humans; Infant; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Middle Aged; Neisseria meningitidis; Senegal; Streptococcus pneumoniae; Survival Rate

This study was conducted to estimate the rate of decreased susceptibility to penicillin (MIC > 0.06-1 microg/ml) in Neisseria meningitidis isolates in Istanbul, Turkey. A total of 30 isolates collected during a 1-y period from patients with meningitis and from nasopharyngeal carriers were tested for penicillin and cefotaxime susceptibility using the E-test. Two out of 12 (17%) clinical isolates and 11/18 (61%) nasopharyngeal isolates showed decreased susceptibility to penicillin with MICs in the range 0.094-1.0 microg/ml, giving an overall resistance of 43% (n = 13). These data show that continued surveillance of trends in antimicrobial susceptibility of N. meningitidis is important for detecting the emergence of N. meningitidis strains with MICs > 1 microg/ml which may pose serious therapeutic problems.

Topics: Adolescent; Adult; Carrier State; Cefotaxime; Cephalosporins; Cerebrospinal Fluid; Child; Female; Humans; Male; Meningitis, Meningococcal; Microbial Sensitivity Tests; Middle Aged; Nasopharynx; Neisseria meningitidis; Penicillin Resistance; Penicillins; Turkey

Meningococcal disease is rare in Mauritius; only one case was reported from 1992 to 1999. However, since June 2000, four cases have occurred. Epidemiologic information and typing results indicate that these recent cases probably followed the introduction of Neisseria meningitidis W135 in Mauritius by pilgrims returning from the Hajj in 2000 and 2001.

Topics: Adult; Cefotaxime; Cephalosporins; Child, Preschool; Disease Outbreaks; Fatal Outcome; Female; Humans; Infant; Male; Mauritius; Meningitis, Meningococcal; Middle Aged; Neisseria meningitidis; Serotyping; Travel

Despite the lack of evidence defining a time interval during which cerebrospinal fluid (CSF) culture yield will not be affected by previous antibiotic therapy, recent publications cite a "minimum window" of 2 to 3 hours for recovery of bacterial pathogens after parenteral antibiotic administration. We conducted a retrospective review of children with bacterial meningitis to describe the rate at which parenteral antibiotic pretreatment sterilizes CSF cultures.. The medical records of pediatric patients who were discharged from a tertiary children's hospital during a 5-year period with the final diagnosis of bacterial meningitis or suspected bacterial meningitis were reviewed. The decay in yield of CSF cultures over time was evaluated in patients with lumbar punctures (LP) delayed until after initiation of parenteral antibiotics and in patients with serial LPs before and after initiation of parenteral antibiotics.. The pathogens that infected the 128 study patients were Streptococcus pneumoniae (49), Neisseria meningitidis (37), group B Streptococcus (21), Haemophilus influenzae (8), other organisms (11), and undetermined (3). Thirty-nine patients (30%) had first LPs after initiation of parenteral antibiotics, and 55 (43%) had serial LPs before and after initiation of parenteral antibiotics. After >/=50 mg/kg of a third-generation cephalosporin, 3 of 9 LPs in meningococcal meningitis were sterile within 1 hour, occurring as early as 15 minutes, and all were sterile by 2 hours. With pneumococcal disease, the first negative CSF culture occurred at 4.3 hours, with 5 of 7 cultures negative from 4 to 10 hours after initiation of parenteral antibiotics. Reduced susceptibility to beta-lactam antibiotics occurred in 11 of 46 pneumococcal isolates. Group B streptococcal cultures were positive through the first 8 hours after parenteral antibiotics. Blood cultures were positive in 74% of cases without pretreatment and in 57% to 68% of cases with negative CSF cultures.. The temptation to initiate antimicrobial therapy may override the principle of obtaining adequate pretreatment culture material. The present study demonstrates that CSF sterilization may occur more rapidly after initiation of parenteral antibiotics than previously suggested, with complete sterilization of meningococcus within 2 hours and the beginning of sterilization of pneumococcus by 4 hours into therapy. Lack of adequate culture material may result in inability to tailor therapy to antimicrobial susceptibility or in unnecessarily prolonged treatment if the clinical presentation and laboratory data cannot exclude the possibility of bacterial meningitis.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Confidence Intervals; Female; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Patient Selection; Spinal Puncture; Time Factors

This study was conducted to elucidate the magnitude of problem and the clinical course of invasive meningococcal infection from 13 government hospitals in Thailand between 1994 and 1999. Thirty-six strains of Neisseria meningitidis were isolated from 16 blood and 24 cerebrospinal fluid specimens; 4 patients had positive culture in both blood and CSF. Of the 16 strains, 9 (56.3%) were serogroup B. Seventy-one and eighty-four percent of the isolates were susceptible to penicillin and cefotaxime/ceftriaxone respectively. Five out of six penicillin-nonsusceptible strains were found to be relatively resistant to penicillin with the MIC of 0.125 microg/ml. Of 33 patients whose medical records were available, 21 were males and 12 were females, with a mean age of 11.2 years. Fifteen patients (45.5%) presented with meningococcemia and 18 patients (54.5%) presented with meningococcal meningitis. Hypotension and purpura were found in 24.2% and 33.3% of patients respectively. The overall mortality rate was 9.1%. In conclusion, meningococcal disease is not common in Thailand, meningococcemia is a life-threatening condition whereas meningococcal meningitis is much less severe. The prevalence of meningococci relatively resistant to penicillin seems to be increasing.

Topics: Adolescent; Adrenal Cortex Hormones; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Child; Chloramphenicol; Female; Hospitals, Public; Humans; Male; Meningitis, Meningococcal; Penicillin G; Thailand

Topics: Administration, Oral; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Cephalosporins; Community-Acquired Infections; Costs and Cost Analysis; Cross Infection; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Humans; Macrolides; Meningitis, Bacterial; Meningitis, Meningococcal; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Neutropenia; Pneumococcal Infections; Pneumonia, Bacterial; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

Topics: Bacteremia; Cefotaxime; Cephalosporins; Child; Female; Humans; Meningitis, Meningococcal; Penicillin Resistance; Penicillins

A retrospective study of infants with bacterial meningitis admitted to our hospital during 1949-52, highlighted the lack of 'classical' signs of meningitis in these infants. We carried out a similar review of 44 infants aged less than three months, admitted during 1982-91. We also determined the causative organisms and their antibiotic sensitivities. Symptoms and signs were similar in the two series. Forty infants in the later series were either febrile, irritable or had seizures on the day of admission. Overall mortality fell from 30% to 11%. Between 1982 and 1991 Group B Streptocococcus and Neisseria meningitidis were the commonest causes of meningitis. All organisms, except one, were sensitive to ampicillin and/or cefotaxime. Bacterial meningitis should be suspected in young infants who are febrile, irritable or having seizures. Initial treatment with ampicillin and cefotaxime is appropriate.

Topics: Ampicillin; Cefotaxime; Fever; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Meningitis, Meningococcal; Retrospective Studies; Seizures; Streptococcal Infections; Streptococcus agalactiae

A 43-year-old black man had recurrence of acute bacterial meningitis caused by Neisseria meningitidis. He had had three previous episodes of acute meningitis, starting at age 27 years. The patient's serum was found to have an undetectable level of the sixth component of complement. Congenital absence of one of the terminal proteins in the complement system impairs a patient's ability to eradicate bacteria, and increases susceptibility to recurring infections caused by meningococci and other Neisseria species. Though the serum of complement-deficient patients promotes normal opsonization of bacteria, it is unable to kill meningococci directly. The currently available meningococcal vaccine may augment type-specific antibody, but it does not correct the underlying complement deficiency. The role of self-administered antibiotics in preventing recurrent Neisseria infection remains uncertain.

Topics: Adult; Ampicillin; Black People; Cefotaxime; Complement System Proteins; Drug Therapy, Combination; Humans; Male; Meningitis, Meningococcal; Military Personnel; Recurrence

Topics: Carrier State; Cefixime; Cefotaxime; Female; Humans; Meningitis, Meningococcal; Middle Aged; Ofloxacin

Topics: Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Humans; Infant; Infant, Newborn; Meningitis; Meningitis, Haemophilus; Meningitis, Listeria; Meningitis, Meningococcal; Meningitis, Pneumococcal

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Cefuroxime; Drug Administration Schedule; Humans; Infant; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal

The pharmacokinetics of ceftriaxone were studied in five infants (7 to 15 months old) and five young children (24 to 70 months old). Both groups received a single 50-mg/kg dose in an intravenous infusion over 5 min. No major pharmacokinetic differences were observed between the two populations. The total (bound plus unbound) plasma concentration-versus-time data could be described in each case by a biexponential equation. Changes in renal clearance indicated time- and dose- dependent pharmacokinetic behavior. The fraction excreted unchanged in the urine (fu) and the biological half-life (t 1/2 (beta)) were, however, dose independent. The average values were 47% for fu (0 to 12 h) and 6.5 for T 1/2 (beta). Weight-corrected total systemic clearance was C1TS = 0.71 ml/min per kg; volume of distribution was VD (beta) = 394 mg/kg. The data support intravenous administration of 50 mg of ceftriaxone per kg of body weight every 12 h in assessing its activity against Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis in postneonatal-stage pediatric patients.

Topics: Cefotaxime; Ceftriaxone; Child, Preschool; Female; Half-Life; Humans; Infant; Infusions, Parenteral; Kinetics; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Protein Binding; Serum Albumin

Ceftriaxone is a wide-spectrum-third generation cephalosporin characterized by outstandingly high efficacy as well as pharmokinetic properties making it suitable for administration in a single daily injection. Ceftriaxone has been found to be useful for treatment of the very severe infectious pathology in countries where hygiene and medical superstructures are still rudimentary. Eighteen of 20 patients with purulent meningitis (13 to Neisseria meningitidis A, 3 to Streptoc. pneumoniae, 1 to Listeria and 3 aseptic) recovered (there being 2 deaths at the 36th hour) after a mean 6 days of hospitalization. Despite the very delicate patient condition, recovery was seen in all 11 cases of very grave bronchopneumopathy, generally due to Streptoc, pneumonia. A dose of 2 g/day in 1 or 2 IV injections is sufficient in the adult, 0.50 g in a single dose being injected to infants weighing less than 10 kg, Meningitis required 4 to 7 days treatment (9 days in a case of Listeria) while the treatment period was longer for respiratory infections. Seven patients had been refractory to treatment with beta-lactamines and/or aminosides, and no adverse drug reactions were noted.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bronchopneumonia; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Female; Hospitals, University; Humans; Infant; Injections; Male; Meningitis; Meningitis, Meningococcal; Meningitis, Pneumococcal; Middle Aged; Niger

Single-dose pharmacokinetics of ceftriaxone were determined in 19 patients with proven bacterial meningitis. The dosage was 50 mg of ceftriaxone per kg. The plasma concentration time curve declined in a biexponential manner. The mean peak plasma concentration was 207 micrograms/ml, and the elimination half-life was 4 h. In 12 patients, multiple-dose pharmacokinetics were determined after a loading dose of 75 mg of ceftriaxone per kg, followed by 50-mg/kg doses every 8 h in 5 patients or every 12 h in 7 patients. The mean peak plasma concentration was 230 micrograms/ml after the first dose and 263 micrograms/ml after the last dose. Of 12 patients, 5 had trough values that were larger after multiple doses than after a single dose. Mean penetration of ceftriaxone into cerebrospinal fluid was 3.1%. The median cerebrospinal fluid bactericidal titer against the patients pathogens was greater than 1:1,024 and less than 1:2,048. The drug was well tolerated without adverse effects.

Topics: Bacteria; Cefotaxime; Ceftriaxone; Child, Preschool; Female; Humans; Infant; Kinetics; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Microbial Sensitivity Tests